Aetna is rolling out new claims cost control measures under its Claim and Code Review Program, beginning Sept. 1.
The new claims editing policy applies to commercial, Medicare and student health members, the company said in June. Aetna may trigger medical record requests for certain submissions, including high-dollar claims, implant procedures, anesthesia services and bundled claims. The insurer already uses the CCRP program to review emergency claims and some other services.
Effective dates vary by state. Washington and Texas providers will see changes on some plans only after regulatory approval, while Maine and Vermont commercial plans will implement updates on different dates.
For coding specifics, Aetna is directing providers to its provider portal on Availity.
